What question did this study set out to answer?

March 10, 2026

Comparative efficacy and safety of ACAF, ACCF, and laminoplasty for multilevel cervical OPLL: A network meta-analysis of observational studies.

Key Points

To compare the clinical efficacy and safety of ACAF, ACCF, and laminoplasty for multilevel cervical OPLL.
Systematic search of PubMed, Cochrane Library, and more for studies comparing ACAF, ACCF, LP.
Analysis of surgical parameters, neurological function, biomechanics, and complications.
Frequentist network meta-analysis using a multivariate random-effects model.
Ranking treatments with surface under the cumulative ranking curve (SUCRA).
ACAF and ACCF achieved better postoperative JOA scores than LP (p < 0.05).
ACAF had the highest likelihood of improving postoperative VAS scores and maintaining cervical curvature.
LP resulted in the shortest operative time.
ACAF had the lowest total complication rate and lower risks for CSF leakage and C5 palsy compared to others.
ACAF's neurological benefits were pronounced in patients with severe stenosis (occupying ratio ≥60%).

Abstract

Study designNetwork Meta-Analysis.ObjectiveTo comprehensively compare the clinical efficacy and safety of anterior controllable antedisplacement and fusion (ACAF), anterior cervical corpectomy and fusion (ACCF), and laminoplasty (LP) for treating multilevel cervical ossification of the posterior longitudinal ligament (OPLL).MethodsPubMed, Cochrane Library, Embase, and Web of Science were systematically searched (inception to April 1, 2025) for clinical studies comparing at least two of ACAF, ACCF, or LP for multilevel (≥2 segments) cervical OPLL. Data on surgical parameters, neurological function (Japanese Orthopaedic Association JOA score, JOA recovery rate, Visual Analog Scale VAS), biomechanics (cervical curvature, Cobb angle, Range of Motion ROM, Neck Disability Index NDI), and complications were extracted. A frequentist network meta-analysis using a multivariate random-effects model was performed. Treatments were ranked using the surface under the cumulative ranking curve (SUCRA).ResultsThirty-one non-randomized studies involving 2616 patients were included (ACAF: 585; ACCF: 875; LP: 1156). NMA showed ACAF and ACCF achieved significantly better postoperative JOA scores and recovery rates than LP (p p p p p p p < 0.05). Subgroup analysis suggested ACAF's benefits, particularly in neurological outcome, are more pronounced in patients with severe stenosis (occupying ratio ≥60%).ConclusionBased on current observational evidence, ACAF appears to be a promising option for multilevel cervical OPLL, particularly for patients with severe stenosis. ACCF provides effective neurological decompression but carries a higher CSF leak risk than ACAF. LP, while having shorter operative times, results in inferior neurological and biomechanical outcomes compared to anterior approaches. Surgical decisions require individualized assessment based on patient and OPLL characteristics.However, these findings should be interpreted with caution due to the predominance of non-randomized studies and potential selection bias.

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Cite This Study

Wang et al. (Sun,) studied this question.

synapsesocial.com/papers/69af963170916d39fea4e1fb https://doi.org/https://doi.org/10.1177/10225536261432365

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